Personal Insurance Checklist

It’s time to take stock!
Just as your health needs an annual checkup – so does your personal insurance program. Although you may not be aware of it, your financial profile changed over the past year. To make sure you, your family and your property are adequately insured for those changes, please complete the questionnaire and press the “Send Checklist” button at the end of the form. We will use the information in your response to evaluate the adequacy of your current insurance program.

Personal Information

Name*

E-mail Address:*

Address*

Street Address

City*

State*

Zip Code*

Phone:*

Best Time to Call:

Checklist Questions

1) Do you have collectibles such as antiques, fine art, stamps, coins, or baseball cards?

Yes

No

2) Do you own valuable jewelry or furs?

Yes

No

3) Do you own costly sporting equipment or firearms?

Yes

No

4) Do you have valuable cameras or other photography equipment?

Yes

No

5) Do you have any alarms installed in your home?

Yes

No

Type of Alarm:

6) Do you keep more than $100 cash in your home?

Yes

No

7) Are your personal belongings insured for their full replacement value?

Yes

No

8) Do you have children away at college?

Yes

No

9) Do you own tools, equipment, or instruments used in your trade or profession?